DESCRIPTION (provided by candidate): Advancements in the treatment and cure of childhood cancer have resulted in a growing population of survivors. While increasing survival rates highlight exceptional triumphs in medical intervention, the lasting consequences of disease and treatment must not be underestimated. Pediatric cancer survivors experience an increased risk of subsequent health complications across a range of organ systems. When deciding whether to engage in unhealthy behaviors, such as smoking, survivors should factor their medical vulnerability into their decision-making. However, research has demonstrated that pediatric cancer survivors often engage in unhealthy behaviors at rates similar to their healthy peers, despite having an increased vulnerability to organ toxicity. Thus, interventions are needed to assist survivors in making informed, healthy decisions about their health behaviors in an effort to prolong their disease-free status. Smoking is an important focus for intervention, given the known connections between smoking and problematic health consequences. In order to inform prevention efforts, it is necessary to better understand what factors influence survivors in their decisions about smoking and to consider these factors within the context of survivors' unique medical context. The objectives of this proposal are: 1) to assess the prevalence of tobacco use in adolescent survivors of pediatric cancer, 2) to determine risk factors associated with tobacco use in this population, and 3) to ascertain if certain groups of survivors are more vulnerable to external influences when deciding to use tobacco. This research will describe biological, psychological, and social variables that are associated with tobacco use in adolescent survivors in order to direct larger investigations and prevention efforts in the future. This research proposal is in keeping with NIDA's research priorities of "understanding the role that...social context play[s] in decision-making and risk taking behaviors" and "understanding the burden of drug addiction in the course of medical illness" (http://www.drugabuse.gov/StrategicPlan/lndex.html). While this investigation will examine smoking within the context of childhood cancer survivorship, findings may illuminate risk factors for smoking that are relevant to other diseases of childhood (e.g., asthma, diabetes). This study is intended to provide important information about risks in order to inform later interventions. [unreadable] [unreadable] [unreadable]